Spiritual Coping in Families of Children in Palliative Care: A Systematic Review

Abstract

Background Palliative care embraces a holistic model that addresses not only physical symptoms but also the psychological, social, and spiritual dimensions of illness. In pediatric settings, where parents face the profound challenge of caring for a terminally ill child, spirituality often becomes a vital source of meaning and strength. Despite its recognized importance, the specific ways in which spirituality supports caregiver coping remain underexplored. This review aims to explore how spirituality contributes as a coping mechanism to families with children in palliative care, and to identify key spiritual practices and beliefs that support their emotional and psychological well-being. Methods A systematic review was conducted using the databases PubMed, Web of Science, and Scopus with a predefined query, ("spiritual coping" OR spirituality OR "spiritual support") AND (families OR parents OR caregivers) AND (children OR pediatric OR "child") AND ("palliative care" OR "hospice care"), yielding 651 articles. Two researchers independently screened articles, assessed methodological quality, and extracted data through consensus. Results Seven qualitative studies met the inclusion criteria, encompassing diverse cultural settings, China, Spain, the United States of America, Malaysia, Indonesia and Canada. Thematic synthesis revealed six domains of spiritual coping: (1) spiritual identity and belief systems, (2) spiritual and religious practices, (3) meaning-making and life philosophy, (4) emotional resilience and transformation, (5) cultural and contextual influences, and (6) spiritual support from healthcare professionals. Conclusions Spirituality emerges as a central, culturally grounded, resource for families and caregivers in pediatric palliative care. Whether religious or secular, spiritual coping supports meaning-making, emotional adaptation and personal transformation. These findings highlight the importance of integrating culturally sensitive, transdisciplinary spiritual care into pediatric palliative services to better support each caregivers' complex and evolving needs.